U.S. patent number 5,971,967 [Application Number 08/914,487] was granted by the patent office on 1999-10-26 for urethral device with anchoring system.
This patent grant is currently assigned to AbbeyMoor Medical, Inc.. Invention is credited to Lloyd K. Willard.
United States Patent |
5,971,967 |
Willard |
October 26, 1999 |
**Please see images for:
( Certificate of Correction ) ** |
Urethral device with anchoring system
Abstract
A device that comprises a tubular-shaped body that is insertable
into a body passageway or cavity, in particular the urethra, and
that has an exterior surface having one or more anchors located
thereon that aid in movement of the device with a minimum of trauma
during placement and that aid in securing the device within the
passageway or cavity during use. The device may be inserted into
either the urethra, bladder neck, or bladder. The anchors can vary
in height, length, number, compressiveness, axial placement,
material characteristics, and helix angle. According to a further
aspect, the one or more anchors are in the form of partial spiral
helixes that function to move and secure the device within the
human urethra. The partial spiral helixes have structures that
allow for the longitudinal movement of the device during
positioning procedures.
Inventors: |
Willard; Lloyd K. (Miltona,
MN) |
Assignee: |
AbbeyMoor Medical, Inc.
(Miltona, MN)
|
Family
ID: |
25434438 |
Appl.
No.: |
08/914,487 |
Filed: |
August 19, 1997 |
Current U.S.
Class: |
604/264; 600/29;
600/30; 604/175; 604/500 |
Current CPC
Class: |
A61M
25/04 (20130101); A61M 25/0075 (20130101); A61M
25/0021 (20130101); A61M 2025/0078 (20130101) |
Current International
Class: |
A61M
25/02 (20060101); A61M 25/04 (20060101); A61M
25/00 (20060101); A61M 005/00 () |
Field of
Search: |
;604/175,174,500,508,264,523,93 ;600/29,30 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
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0 753 289 A1 |
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Jan 1997 |
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EP |
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564.832 |
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Jan 1924 |
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FR |
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2 219 941 |
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Dec 1989 |
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GB |
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2 219 943 |
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Dec 1989 |
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GB |
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WO 95/17862 |
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Jul 1995 |
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WO |
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WO 97/06758 |
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Feb 1997 |
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WO |
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WO 97/25090 |
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Jul 1997 |
|
WO |
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WO 98/06354 |
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Feb 1998 |
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WO |
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Other References
Hayes, O., M.D., "Spiral Urethral Dilator," Jour. A. M. A., Sep.
18, 1926, vol. 87, No. 12, pp. 939-940..
|
Primary Examiner: Yasko; John D.
Attorney, Agent or Firm: Brinks Hofer Gilson & Lione
Claims
I claim:
1. A device for placement in a urethra comprising:
a tubular body sized for placement in said urethra, said tubular
body having a proximal portion adapted for placement toward a
bladder end of said urethra and a distal portion opposite from said
proximal portion, said tubular body having an exterior surface;
and
a plurality of anchors extending outward from said exterior
surface, wherein each of said plurality of anchors extends less
than 360.degree. around said exterior surface.
2. The invention of claim 1 wherein each of said plurality of
anchors extends less than 180.degree. around said exterior
surface.
3. The invention of claim 1 wherein each of said plurality of
anchors extends less than 90.degree. around said exterior
surface.
4. The invention of claim 1 wherein each of said plurality of
anchors has associated therewith tapered end portions extending
from a main portion thereof and tapering toward said exterior
surface of said tubular body.
5. The invention of claim 1 wherein each of said plurality of
anchors is comprised of an elongate ridge having a height extending
in a radial direction relative to an axis of said tubular body, and
a length extending in a direction generally around a circumference
of said tubular body, and wherein said height varies along said
length tapering from a maximum height located along said length of
said ridge.
6. The invention of claim 1 wherein each of said plurality of
anchors extends helically around said exterior surface.
7. The invention of claim 1 wherein said tubular body comprises a
wall that defines a passageway extending from said proximal portion
to said distal portion and further wherein said tubular body has a
proximal opening located in said proximal portion and communicating
with said passageway and a distal opening located in said distal
portion and communicating with said passageway.
8. The invention of claim 7 wherein a distal portion of said
passageway includes a recess for receiving an insertion tool.
9. The invention of claim 7 wherein the proximal opening comprises
an open through-lumen.
10. The invention of claim 7 wherein the proximal opening comprises
a port.
11. The invention of claim 7 further comprising a valve located in
said passageway.
12. The invention of claim 1 wherein said tubular body has a length
such that said distal portion extends outside the urethra during
use.
13. The invention of claim 1 wherein said tubular body has a length
such that a distal end is retained inside the urethra during
use.
14. The invention of claim 1 wherein said tubular body has a length
such that a proximal end is positioned in the bladder during
use.
15. The invention of claim 1 wherein at least one of said plurality
of anchors has a height different from a height of another of said
plurality of anchors.
16. The invention of claim 1 wherein each of said plurality of
anchors has a maximum height of approximately 100% of a base
diameter of said tubular body.
17. The invention of claim 1 wherein said plurality of anchors are
located in a non-uniform pattern along a length of said tubular
body.
18. The invention of claim 1 wherein said plurality of anchors
define non-repeated pathways along a length of said tubular
body.
19. The invention of claim 1 wherein said device has a size between
6 and 24 French.
20. The invention of claim 1 wherein said exterior surface is
constructed of a material selected from a group consisting of:
molded silicone, latex, polyurethane, polyethylene, and
polycarbonate.
21. The invention of claim 1 further comprising:
at least one sealer ring located on said proximal portion and
extending around said tubular body.
22. The invention of claim 21 wherein said at least one sealer ring
is formed of a pliable material.
23. The invention of claim 1 further comprising:
at least one sealer ring located on said distal portion and
extending around said body.
24. The invention of claim 1 further comprising:
a plurality of sealer rings located on said proximal portion and
extending around said body.
25. The invention of claim I wherein said body is formed of
silicone rubber.
26. The invention of claim 1 wherein said body is formed of a
material having a Durometer hardness in a range between
approximately 20 and 80 Shore.
27. The invention of claim 1 wherein said body is formed of a
material having a Durometer hardness of approximately 60 Shore.
28. The invention of claim 1 further comprising a marker located at
said proximal portion.
29. The invention of claim 1 wherein said tubular body comprises a
wall that defines a passageway extending from said proximal portion
to said distal portion and further wherein said tubular body has a
proximal opening located in said proximal portion and communicating
with said passageway and a distal opening located in said distal
portion and communicating with said passageway, and further wherein
a magnetically-actuatable valve is located in said passageway.
30. The invention of claim 1 wherein said plurality of anchors are
located in a uniform pattern along a length of said tubular
body.
31. The invention of claim 1 wherein said plurality of anchors
define repeated pathways along a length of said tubular body.
32. A device for placement in a urethra comprising:
a tubular body sized for placement in said urethra, said tubular
body having a cylindrical-shaped wall having an exterior surface,
said tubular body having a proximal portion adapted for placement
toward a bladder end of said urethra and a distal portion opposite
from said proximal portion; and
a plurality of anchors located on said exterior surface, each of
which is comprised of an elongate ridge having a height extending
in a radial direction relative to an axis of said tubular body, a
length extending in a direction generally around a circumference of
said tubular body, and a width perpendicular to said length and
parallel to said axis, and wherein said ridge has a middle portion
along its length where its height defines a distally-oriented
surface that engages a wall of said urethra to anchor said tubular
body therein, wherein said middle portion extends less than
360.degree. around said exterior surface of said tubular body.
33. The invention of claim 32 wherein said tubular body defines a
passageway extending from said proximal portion to said distal
portion, said tubular body having a proximal opening located in
said proximal portion and communicating with said passageway and a
distal opening located in said distal portion and communicating
with said passageway.
34. A tubular device for placement in a urethra to provide a
passageway therein comprising:
a tubular body sized for placement in the urethra, said tubular
body having a cylindrical-shaped wall having an exterior surface,
said tubular body defining a lumen extending from a proximal
portion to a distal portion thereby providing a passageway through
said tubular body, said proximal portion adapted for placement
toward a bladder end of the urethra; said tubular body having a
proximal opening located in said proximal portion and communicating
with said lumen and a distal opening located in said distal portion
and communicating with said lumen;
a plurality of anchoring ridges, wherein each of said plurality of
anchoring ridges extends from said exterior surface and has a
distally-facing surface, and wherein each of said plurality of
anchoring ridges extends less than 360.degree. around said exterior
surface.
35. The invention of claim 34 wherein said distally-facing surface
forms an acute angle with said exterior surface of said tubular
body.
36. The invention of claim 34 wherein said distally-facing surface
forms an angle of at least approximately 30.degree. with said
exterior surface of said tubular body.
37. The invention of claim 34 wherein said anchoring ridges deflect
radially when pressure is applied to said tubular body.
38. The invention of claim 34 wherein each of said plurality of
anchoring ridges has a proximally-facing surface, and wherein said
proximally-facing surface forms an obtuse angle with said exterior
surface of said tubular body.
39. The invention of claim 34 wherein each of said plurality of
anchoring ridges is longitudinally displaced from one another along
said exterior surface.
40. A device for placement in a urethra to provide a passageway
therein comprising:
an elongate tubular body sized for placement in the urethra, said
tubular body having a cylindrical-shaped wall having an exterior
surface, said tubular body defining a lumen extending from a
proximal portion to a distal portion thereby providing said
passageway, said proximal portion adapted for placement toward a
bladder end of said urethra; said tubular body having a proximal
opening located in said proximal portion and communicating with
said lumen and a distal opening location in said distal portion and
communicating with said lumen;
a first anchor extending outward from said exterior surface and
extending around said exterior surface through an angle of less
than 360.degree.; and
at least one additional anchor extending outward from said exterior
surface and extending around said exterior surface through an angle
of less than 360.degree., said at least one additional anchor
longitudinally displaced from said first anchor.
41. The invention of claim 40 wherein said at least one additional
anchor is displaced circumferentially from said first anchor.
42. The invention of claim 40 wherein said first anchor and said at
least one additional anchor each extend less than 180.degree.
around said exterior surface.
43. The invention of claim 40 wherein each of said anchors extends
less than 90.degree. around said exterior surface.
44. The invention of claim 40 wherein each of said anchors extends
helically around said exterior surface.
45. The invention of claim 40 further comprising:
a tapered leading edge associated with each of said anchors and
extending from its associated anchor to a point of divergence with
said exterior surface; and
a tapered trailing edge associated with each of said anchors and
extending from its associated anchor to a point of convergence with
said exterior surface.
46. A device for placement in a urethra comprising:
a tubular body defining an interior passageway and having proximal
and distal opening communicating therewith, wherein a proximal end
of said tubular body is oriented toward the bladder when positioned
in the urethra; and
a non-continuous spiral ridge located on an exterior surface of
said tubular body and extending outwardly therefrom, said
non-continuous spiral ridge comprised of a plurality of continuous
spiral sections wherein each of said continuous spiral sections
extends less than 360.degree. around said tubular body.
47. A device for placement in a urethra comprising:
a tubular body sized for placement in said urethra, said tubular
body having a proximal portion adapted for placement toward a
bladder end of said urethra and a distal portion opposite from said
proximal portion, said tubular body having an exterior surface;
and
a plurality of anchors extending outward from said exterior surface
wherein said anchors form a sinusoidal protrusion along a side of
the exterior surface.
48. A device according to claim 47 wherein said anchors extend
360.degree. around said exterior body.
49. A device according to claim 47 wherein said anchors extend less
than 360.degree. around said exterior body.
50. A device according to claim 47 wherein the sinusoidal
protrusion along the side of the exterior surface is offset from a
sinusoidal protrusion along a second side of the exterior
surface.
51. A device according to claim 47 wherein the sinusoidal
protrusion along the side of the exterior surface is aligned with a
sinusoidal protrusion along a second side of the exterior
surface.
52. The invention of claim 47 wherein each of said plurality of
anchors extends less than 180.degree. around said exterior
surface.
53. The invention of claim 47 wherein each of said plurality of
anchors extends less than 90.degree. around said exterior
surface.
54. The invention of claim 47 wherein each of said plurality of
anchors extends helically around said exterior surface.
55. The invention of claim 47 wherein said tubular body comprises a
wall that defines a passageway extending from said proximal portion
to said distal portion and further wherein said tubular body has a
proximal opening located in said proximal includes a recess for
receiving an insertion tool.
56. The invention of claim 55 wherein the proximal opening
comprises an open through-lumen.
57. The invention of claim 55 wherein the proximal opening
comprises a port.
58. The invention of claim 55 further comprising a valve located in
said passageway.
59. The invention of claim 47 wherein said tubular body has a
length such that said distal portion extends outside the urethra
during use.
60. The invention of claim 47 wherein said tubular body has a
length such that a distal end is retained inside the urethra during
use.
61. The invention of claim 47 wherein said tubular body has a
length such that a proximal end is positioned in the bladder during
use.
62. The invention of claim 47 wherein said device has a size
between 6 and 24 French.
63. The invention of claim 47 wherein said exterior surface is
constructed of a material selected from a group consisting of:
molded silicone, latex, polyurethane, polyethylene, and
polycarbonate.
64. The invention of claim 47 further comprising:
at least one sealer ring located on said proximal portion and
extending around said tubular body.
65. The invention of claim 64 wherein said at least one sealer ring
is formed of a pliable material.
66. The invention of claim 47 further comprising:
at least one sealer ring located on said distal portion and
extending around said body.
67. The invention of claim 47 further comprising:
a plurality of sealer rings located on said proximal portion and
extending around said body.
68. The invention of claim 47 wherein said body is formed of
silicone rubber.
69. The invention of claim 47 wherein said body is formed of a
material having a Durometer hardness in a range between
approximately 29 and 80 Shore.
70. The invention of claim 47 wherein said body is formed of a
material having a Durometer hardness of approximately 60 Shore.
71. The invention of claim 47 further comprising a marker located
at said proximal portion.
72. The invention of claim 47 wherein said tubular body comprises a
wall that defines a passageway extending from said proximal portion
to said distal portion and further wherein said tubular body has a
proximal opening located in said proximal portion and communicating
with said passageway and a distal opening located in said distal
portion and communicating with said passageway, and further wherein
a magnetically-actuatable valve is located in said passageway.
73. A device for placement in a urethra comprising:
a tubular body sized for placement in said urethra, said tubular
body having a proximal portion adapted for placement toward a
bladder end of said urethra and a distal portion opposite from said
proximal portion, said tubular body having an exterior surface;
and
a plurality of anchors extending outward from said exterior surface
wherein said anchors form an undulating pattern along said exterior
surface.
74. A device according to claim 73 wherein said anchors extend
360.degree. around said exterior body.
75. A device according to claim 73 wherein said anchors extend less
than 360.degree. around said exterior body.
76. A device according to claim 73 wherein the sinusoidal
protrusion along the side of the exterior surface is offset from a
sinusoidal protrusion along a second side of the exterior
surface.
77. A device according to claim 73 wherein the sinusoidal
protrusion along the side of the exterior surface is aligned with a
sinusoidal protrusion along a second side of the exterior
surface.
78. A device according to claim 73 wherein each of said plurality
of anchors extends less than 180.degree. around said exterior
surface.
79. The invention of claim 73 wherein said tubular body comprises a
wall that defines a passageway extending from said proximal portion
to said distal portion and further wherein said tubular body has a
proximal opening located in said proximal includes a recess for
receiving an insertion tool.
80. The invention of claim 79 wherein the proximal opening
comprises an open through-lumen.
81. The invention of claim 79 wherein the proximal opening
comprises a port.
82. The invention of claim 79 further comprising a valve located in
said passageway.
83. The invention of claim 73 wherein said tubular body has a
length such that said distal portion extends outside the urethra
during use.
84. The invention of claim 73 wherein said tubular body has a
length such that a distal end is retained inside the urethra during
use.
85. The invention of claim 73 wherein said tubular body has a
length such that a proximal end is positioned in the bladder during
use.
86. The invention of claim 73 wherein said device has a size
between 6 and 24 French.
87. The invention of claim 73 wherein said exterior surface is
constructed of a material selected from a group consisting of:
molded silicone, latex, polyurethane, polyethylene, and
polycarbonate.
88. The invention of claim 73 further comprising:
at least one sealer ring located on said proximal portion and
extending around said tubular body.
89. The invention of claim 88 wherein said at least one sealer ring
is formed of a pliable material.
90. The invention of claim 73 further comprising:
at least one sealer ring located on said distal portion and
extending around said body.
91. The invention of claim 73 further comprising:
a plurality of sealer rings located on said proximal portion and
extending around said body.
92. The invention of claim 73 wherein said body is formed of
silicone rubber.
93. The invention of claim 73 wherein said body is formed of a
material having a Durometer hardness in a range between
approximately 29 and 80 Shore.
Description
BACKGROUND OF THE INVENTION
The present invention relates generally to urethral apparatuses and
methods of use, and more particularly to a urethral apparatus that
can be positioned in the urethra for short-term or long-term use,
relatively comfortably but securely.
Urinary problems can have serious consequences, particularly when
the problem is one of retention or ischuria. Urine flow problems
include urine retention, incontinence, and difficult urination.
Retention can result from any of a number of causes, including
without limitation, spinal cord injury or tumors, coma, typhoid,
peritonitis, prostatic enlargement, urethral stricture, urethritis,
cystitis, bladder tumors, urethral calculus, Parkinson's disease,
prostatitis, or multiple sclerosis. Patients suffering from these
and other conditions often require some interventional means to
periodically drain the bladder. Failure to do so can result in
damage of the epithelium and detrusor muscles associated with the
bladder, and an increased potential for bacterial invasion and
urinary tract infection potentially leading to life-threatening
kidney failure.
Another urine flow problem is that of incontinence, which is the
inability to retain urine because of paralysis or relaxation of
sphincters or contraction of longitudinal muscular layers of the
bladder. Incontinence can also occur in coma, epileptic seizure,
spinal cord injury or tumors associated with the spinal cord,
spinal meningitis, or local irritation of the bladder. Incontinence
is usually categorized as either stress incontinence, in which
urine is expelled during stresses such as exercise, coughing, and
laughing; urge incontinence, in which the patient in unable to
control the urge to urinate in part due to uninhibited bladder
contractions; or mixed incontinence, in which the patient
experiences both stress and urge incontinence.
Difficult urination or dysuria can result from urethral strictures,
enlarged prostates, atony and impairment of the bladder's muscular
power, and inflammatory conditions involving the urethra, bladder,
or lower ureter.
Devices have been developed to be positioned in the urethra and/or
bladder to correct the problems of urine flow. Urinary drainage
catheters and devices have a long history, and many approaches have
been taken to keeping these devices in place. Many of these devices
suffer from one or more problems. For example, some of these
devices may have been difficult or uncomfortable to place into
position or to retain in position after placement. Also, some of
these devices may have tended to leak or become dislodged
unintentionally. Further, some of these devices have led to
infections.
Accordingly, it is an object to provide a device that is easily and
atraumatically inserted and removed. It is another object to
provide a device that can be positioned in the urethra with a
minimum of stress to the urethra and with a minimum of bacterial
migration. It is still a further object to provide a device that
can remain in position in the urethra and withstand pressure
impulses due to stresses such as coughing, laughing, or
exercising.
SUMMARY OF THE INVENTION
To address the above concerns, the present invention provides a
device that comprises a tubular-shaped body that in insertable into
a body passageway or cavity, in particular the urethra, and that
has an exterior surface having one or more anchors located thereon
that aid in movement of the device with a minimum of trauma during
placement and that aid in securing the device within the passageway
or cavity during use. The device may be inserted into either the
urethra, bladder neck, or bladder.
According to a further aspect, the one or more anchors on the
device are in the form of partial spiral helixes that function to
move and secure the device within the human urethra. The partial
spiral helical anchors have structures that allow for the
longitudinal movement of the device during positioning procedures.
These anchors can vary in height, length, number, compressiveness,
axial placement, material characteristics, and helix angle. In
addition, leading and trailing edges associated with each of the
anchors provide a tapered gradual increase up to a maximum height
of each of the anchors to ease insertion and removal of the device
and to prevent a shearing effect that could result from a blunt or
aggressive leading edge.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is an expanded elevational view of one present embodiment
showing an indwelling urethral device positioned within the
urethra.
FIG. 2 is a partial sectional elevational view of the urethral
device of the embodiment of FIG. 1.
FIG. 3 is an elevational view of the urethral device of FIG. 1
coupled with an installation tool.
FIGS. 4 and 5 are partial sectional views illustrating the coupling
apparatus at the interface of the installation tool and the
urethral device shown in FIG. 3.
FIGS. 6a and 6b are expanded elevational views showing an alternate
embodiment of the urethra device positioned within the urethra.
FIG. 7 is a sectional view of the distal portion of the embodiment
of FIGS. 6a, and 6b.
FIG. 8 is a partial sectional elevational view of the embodiment of
FIGS. 6a, 6b, and 7.
FIGS. 9-13 are elevational views of further alternate embodiments
of the urethral device for human males.
FIGS. 14-16 are elevational views of further alternate embodiments
of the urethral device for human females.
FIGS. 17 and 18 are views of further alternate embodiments of the
urethral device showing sinusoidal surfaces.
FIG. 19 is a partial elevational sectional assembly view of an
embodiment of the urethral device with a magnetically-actuated
valve assembly.
FIG. 20 is a perspective view of the magnetic tumbler in the
embodiment of FIG. 19.
FIG. 21 is an expanded perspective view of the distal support
flange of FIG. 19.
FIG. 22 is an expanded perspective view of the proximal support
flange of FIG. 19.
FIG. 23 is an expanded perspective view of the seat of FIG. 19.
FIG. 24 is an elevational view of another embodiment of an
indwelling urethral device positioned within the urethra.
FIG. 24A is a cross sectional view of the embodiment of FIG. 24
taken along line 24A-24A'.
FIG. 25 is an elevational view of a further embodiment of an
indwelling urethral device positioned within the urethra.
FIG. 25A is a cross sectional view of the embodiment of FIG. 25
taken along line 25A-25A'.
FIG. 26 is an elevational view of still another embodiment of an
indwelling urethral device positioned within the urethra.
FIG. 26A is a cross sectional view of the embodiment of FIG. 26
taken along line 26A-26A'.
DETAILED DESCRIPTION OF THE PRESENTLY PREFERRED EMBODIMENTS
First Embodiment: FIGS. 1 and 2 show a first preferred embodiment
of a device 10. The device 10 is positioned in a urethra 30 and
extends partially into a bladder 60 of a patient. The patient may
be either a male or female human, or alternatively, embodiments of
device may be used in other mammals or even other animals, with
suitable changes in dimensions. The device 10 has a body 16 having
a proximal portion 11 terminating in a proximal end 12 and distal
portion 13 terminating in a distal end 14. The body 16 has a
generally tubular shape around axis 15. The cross sectional shape
of the body may be generally round or may be flattened to conform
to the anatomical shape of the urethra. The body 16 includes a wall
17 having an exterior surface 19. The proximal portion 11 of the
body 16 has at least one port 18 which may be located at the
proximal end 12 to allow for urine flow into and through the
device. Alternately, the proximal end 12 could have an open
through-lumen to allow for the device to be used as an introducer
for fluids, stents, or other devices or to function as a temporary
stent itself for diagnostic and therapeutic procedures in the lower
or upper urinary tract. The distal portion 13 of the device 10 can
extend outside the body, or it can be retained entirely within the
body. Those embodiments that extend outside the body can, for
example, be connected to a fluid collection or introducer system,
and embodiments retained entirely within the body can have
additional elements or capabilities, such as a fluid valving or
drug delivery.
Located along the length of the body 16 and extending outward from
it are a plurality of anchors 20, such as anchors 20A and 20B, that
aid in the insertion, withdrawal, and securing of the device within
the urinary tract. In the embodiment of FIGS. 1 and 2, each of
these anchors takes the form of a partial helical protrusion or
ridge. These anchors 20 can vary in height, length, number,
compressiveness, axial placement, material characteristics, and
helix angle from 0 to 300 degrees, and more preferably from 15 to
300 degrees. Each anchor includes a leading edge 22 and a trailing
edge 23 which taper from a middle portion 21 of the anchor for
atraumatic insertion and withdrawal of the device. The anchors 20
can have the same or different amplitudes along the body 16, so
long as proper retention is achieved. The height or amplitude of
each of the anchors 20 can vary between the points of divergence 24
and convergence 25 with the body 16 of the device and has a maximum
amplitude occurring along the middle portion 21. The maximum
amplitude may extend along the entire length of the middle portion
21 of the anchor, or may extend along only part of the middle
portion. Further, the maximum amplitude may be located
approximately midway between the points 24 and 25 or may be located
toward either the leading or trailing edges. The maximum amplitude
of each anchor may be up to 100% of the base diameter of body 16 in
extreme cases where the urethra is relatively atonic. The height of
each anchor 20 defines a proximal surface 27 and distal surface 29.
In the present embodiment, the profile of each anchor along its
length is in a shape comparable to a half sinusoid. In a present
embodiment, the anchors 20 are composed of the same material as the
body 16 and are formed as part of a molding process during which
the body is also formed. Alternatively, the anchors may be attached
to the body after formation by suitable means, such as fusing,
adhesives, etc.
Each anchor has a length that extends in a direction around the
surface of the tubular body 16. In a present embodiment, each
anchor extends only part way, i.e. less than 360.degree., around
the circumference of the tubular body 16, and more preferably each
anchor has a length such that it extends less than 180.degree.
around the circumference of the body. In some embodiments, each
anchor may extend less than 90.degree. around the circumference of
the body. In an alternative embodiment, the middle portion 21 of
the anchor extends only part way, i.e. less than 360.degree. or
more preferably less than 180.degree., around the circumference of
the tubular body 16; however, the leading and trailing edges 22 and
23 associated with the anchor may extend the overall length of the
anchor and edges such that the points of convergence and divergence
25 and 24 may be greater than 360.degree. apart from each
other.
To minimize trauma to the urethra 30, the anchors 20 are preferably
few in number (2-16, and more preferably 2-6) and are located in a
random or non-uniform pattern along the length of body 16 as shown
in FIGS. 1 and 2 so that the anchors 20 have a non-repeated pathway
or point of contact with the urethral wall 32 as device 10
progresses along the urethra 30. Optionally, the anchors can have
repeated pathways. In one embodiment, the plurality of anchors form
a non-continuous helical ridge composed of individual helical
sections each of which is less than a complete turn around the
tubular body. The anchors 20 and their locations overcome a
deficiency in the prior art that relies upon a complete or
continuous helical surface to advance and seal a device in the
urethra. A complete or continuous helical surface provides a
perpetual, or time-prolonged, shunt pathway for urine. By not
providing a continuous pathway, as shown in FIG. 1, the urethral
wall is allowed to seal against the flat surfaces of the body
thereby providing improved retention.
In the one preferred embodiment, the device 10 does not extend
outside the body but resides entirely within the urinary tract,
preferably primarily within the urethra, except to the extent to
which the proximal end 12 extends partially or completely into
either the bladder 60 or the bladder neck 50. Although the device
10 may be as long or longer than the urethra, in one preferred
embodiment it is preferably less than 10 cm in versions for male
users and 5 cm in versions for female users. There are, however,
certain applications, including certain short-term applications,
that would benefit from having an alternate embodiment of the
device (not shown) wherein the device has a length such that a
distal end 14 extends outside the body while still having the
proximal end 12 positioned within the bladder or the bladder neck.
The device 10 has a preferred size from approximately 10 French to
34 French to accommodate the range of urethral sizes from infants
to adults, although sizes larger and smaller may be used if
suitable, including sizes as small as 6 French. In one presently
preferred embodiment, the outside surface of the device 10 is
constructed of either molded silicone or latex. Alternative
materials include molded polyurethane, polyethylene, polycarbonate,
or other biocompatible materials.
Along the proximal portion 11 of the device 10 are one or more
sealer rings 26, such as sealer rings 26A, 26B, and 26C. These
sealer rings 26 assist in preventing the flow of urine around the
outside of the device. These sealer rings are optional. These
sealer rings 26 extend around the full circumference of the tubular
body 16 and can vary in height, length, number, compressiveness,
axial placement, material characteristics, and helix angle. Because
the proximal-most sealer ring or rings may be located in the
bladder neck 50 or bladder 60, which has a larger diameter than the
urethra 30, these proximal-most sealer rings 26 may have a greater
height than any sealer rings which are located more distally. The
sealer rings 26 and the pressure of the urethra 30 against the flat
surfaces (i.e., portions without anchors) of the tubular body 16 of
the device 10 prevent the leakage of urine around the outside of
the tubular body 16. Although the sealer rings 26 may be located
only at the proximal portion 11 to prevent urine leakage to escape
distally, additional sealer rings 26 may also be located at the
distal portion 13 or elsewhere along the length of the tubular body
16. Optionally, the function of the sealer rings 26 can be replaced
with surface coatings, by selecting the size of the tubular body 16
to have more intimate contact with the urethra 30, or by changing
the material composition or characteristics of the device 10.
A preferred characteristic of the sealer rings 26 is pliability. As
the device 10 is advanced through the urethra 30, such as during
placement, the sealer rings 26 are oriented downwardly (i.e.,
distally). After the device 10 is fully inserted, a slight reverse
movement of the device causes the sealer rings 26 to flip to an
upward position (proximally). In this position, the downward
pressure of urine against the sealer rings 26 causes them to
depress downward (but not flip downward) and seal tightly against
the urethra 30, thus preventing leakage of urine around the
exterior of the device 10. In one embodiment the device 10 is
produced using a composite construction of a base tube and cast
external features. A base tube is constructed as a braid reinforced
silicone tube using a stainless steel wire braid and Shore A 60
durometer silicone compound as the tube polymer (tubing produced by
New England Electric Wire Corp. Lisbon, N.H.). The internal
diameter of the base tube is 0.160 inches using a braid core
diameter of 0.180 inches. The external diameter of the base tube is
0.210 inches. Anchor features are then cast onto the outer
circumference using a Shore A 30 Durometer silicone rubber
compound. The specific compounds used for casting the anchoring and
sealing features are RTV 430 silicone rubber resin and Beta 11-D1
silicone catalyst solution, both manufactured by GE Silicones of
Waterford, N.Y. Alternate embodiments of the device can be made by
allowing the external features' hardness to vary using compounds
with Shore A Durometers ranging from 10 to 80.
Referring to FIG. 2, there is shown a partial, sectional view of
the device 10. The body 16 defines a passageway or lumen 31 that
extends through the length of the body 16 from the proximal port 18
to a distal opening 33. A marker 34 (which may be metallic or other
suitable material) is located near the proximal end 12 of device 10
and functions to help locate or position the device using
ultrasound, x-ray, or other technology. The first partial view of
the distal end 14 shows an inner recess 42 in the lumen 31
immediately proximal of the distal opening 33. The inner recess 42
is shaped to receive a proximal end of an insertion tool 100 (shown
in FIG. 3 and described in detail in copending application Ser. No.
60/036,944, filed Feb. 7, 1997, the entire disclosure of which is
incorporated herein by reference). The second partial view further
shows a braid 44 which is embedded in or located inside the tubular
body 16 and which provides for radial size stability and torsional
stability while the device 10 is being inserted and removed. A
preferred material for the braid is 316L Hard Stainless Steel wire
of 0.002 inch diameter (wire gage 44). The braid's preferred
construction is 2 ends per carrier with 16 carriers. The braid's
preferred pitch is approximately 14 picks per inch. This braid
construction generates a braid angle of 45.3 degrees for adequate
torsional stiffness and 15.1% coverage which allow adequate bond
areas for subsequent polymer attachment. Alternately, the braid 44
may be a round wire in sizes from 0.001 to 0.010 inch in diameter
or larger, or flat wire ranging in sizes from 0.0005.times.0.0025
to 0.006.times.0.015.
Placement of the Urethral Device: Referring to FIGS. 3 through 5,
the insertion tool 100 can be used to couple with the device 10 to
aid insertion, or the insertion tool 100 and device 10 may each
optionally be provided with various electrical, optical, fluid, or
mechanical circuits, channels, or linkages that cooperate together
to provide feedback signals that indicate the location of the
device and/or that the device is properly located with respect to
anatomical features.
The insertion tool 100 has a handle 102 and a linkage 104 that
passes through a shaft 106 thereof. The linkage 104 is connected to
an actuating mechanism in the handle 102, such as a plunger 108.
Actuating the plunger 108 changes the shape and/or diameter of a
deformable coupling 110 located at a proximal end of the insertion
tool so that the deformable coupling 10 has a smaller first profile
prior to coupling with the distal end 14 of device 10 (FIG. 4) and
a second larger profile when coupled to device 10 (FIG. 5).
To use the insertion tool to position the device 10, the insertion
tool 100 and the device are coupled together as shown in FIG. 3.
The device is inserted into the urethra. The device may be inserted
with a combined rotational and forward (proximal) movement, or
alternatively, the device may be inserted with forward movement
only. Upon appropriate positioning of the device, which can be
facilitated by suitable indicating means, such as ultrasound,
x-ray, or any of the indicating means disclosed in the copending
application Ser. No. 60/036,944, the insertion tool is decoupled
from the device and removed. The device is now positioned for
short- or long-term use.
As known in the art, anchoring of the device can be enhanced by the
use of adhesives or adhesive-like compounds along all or a portion
of the device. In addition, the exterior portion of the embodiment
of the device that extends outside the body can further have a
meatal flange or flared portion to prevent unwanted migration into
the bladder, to contribute to anchoring the device, to further seal
against leakage, and to absorb unwanted urine leakage. The meatal
flange can be shaped to cooperate with the user's anatomy.
First Alternate Embodiment. FIGS. 6a through 8 illustrate an
alternate embodiment 200 of the urethral device. In this
embodiment, a urethral device is provided with foldable or highly
bendable anchors 220 that allow for a dynamic response to the
increased pressure placed on the device by either the urethra,
bladder neck, bladder, or the fluids in the urethra or bladder.
Each of the anchors 220 has an angulated recess 221 that is
flexible in response to either urethral stresses or dynamic forces
working on the device. The foldable characteristic still allows for
rotational movement of the device within the urethra, while
simultaneously allowing for a relatively non-traumatic anchoring
when positioned.
Referring to FIGS. 6a through 8, some of the components are the
same or similar to the components in the previously described
embodiment and like components are labeled with the same numbers.
In this embodiment, the anchors 220 are thinner, more flexible, and
more responsive to pressure impulses incumbent upon the device 200.
In a preferred embodiment, these anchors 220A and 220B are formed
of partial helical ridges or protrusions. Because of their shape,
angle, material characteristics, and dynamic nature, the anchors
220 may engage the urethral wall 32 somewhat more definitively than
in the previous embodiment. FIG. 6a illustrates the device 200 in a
relatively unstrained position, and FIG. 6b illustrates the device
200 in a relatively more engaged position. To be most effective, a
distal surface 241 of each of these anchors 220 forms an acute
angle (shown at 246) of approximately 30degrees or greater, and
preferably approximately 45 degrees, with the exterior surface 19
of the tubular body 16 as shown in FIG. 7. The proximal surface 243
of each of these anchors 220 may form an obtuse angle with the
exterior surface 19 of the tubular body 16. When the device 200
undergoes pressure from urine accumulation in the bladder or
experiences pressure impulses from coughing, laughing, exercising,
or other such stresses, the device 200 may have a slight tendency
to be displaced distally. Overcoming these forces will be the
action of the anchors 220 against the urethral wall 32. When
pressure or impulses are placed upon the device 200 and when the
device 200 experiences a slight distal displacement, the anchors
220 deflect radially and exert additional pressure against the
urethral wall 32. In this manner, the anchors 220 serve not only to
secure the device in place, but also to dampen pressure impulses
incumbent upon it. Because the profile of the anchors 220 is
foldable or highly flexible, the device 200 may be installed either
with rotational motion or by moving from a distal position to a
proximal position by a non-rotating, longitudinal motion only.
Although the device 200 may be installed without rotation,
non-traumatic removal may require rotational motion. FIG. 8 shows a
partial sectional elevational view of the device 200, showing a
distal inner recess 242 that is shaped to receive the proximal end
of the insertion tool 100. Also shown using hidden lines is the
length and position of the anchors 220. The height, length, number,
axial placement, and helix angle of the anchors 220 may be similar
to those described above in connection with the previous
embodiment.
Additional Alternate Embodiments: In alternative embodiments, the
optional sealer rings 26 may be located only at the proximal
portion 11 or alternatively the sealer rings may be additionally
located at the distal portion 13 of the device 10 (or the device
200). It is envisioned that the sealer rings 26 and anchors 20 (or
220) can be intermixed in any of a number of sequences, as shown in
FIG. 9 through FIG. 13 which illustrate male versions of the
device, and in FIG. 14 through FIG. 16 which illustrate female
versions of the device. FIG. 9 shows an embodiment in which the
sealer rings 26 and the anchors alternate along the length of the
body. FIG. 10 shows an embodiment in which the sealer rings are
located only at the proximal portion of the tubular body and
wherein a relatively greater number of anchors are located along
the length of the body in an irregular pattern. FIG. 11 shows an
embodiment with relatively fewer anchors compared to the embodiment
of FIG. 10 and in which the sealer rings are located only at the
proximal portion. FIG. 12 shows an embodiment in which the anchors
are formed of relatively wide undulations which spiral around the
exterior surface of the tubular body and further which includes
sealer rings located only at the proximal portion. FIG. 13 shows an
embodiment in which the anchors are formed of relatively wide
undulations which encircle (but do not necessarily spiral around)
the exterior surface of the tubular body and further which includes
sealer rings located only at the proximal portion. FIG. 14 shows a
female version with proximal sealing rings and relatively few
anchors which are formed of partial helical ridges. FIG. 15 shows a
female version of the device in which sealer rings are located only
at the proximal and distal portions and wherein the anchors are
located along the middle portion of the body in an irregular
pattern. FIG. 16 shows a female version of the device with sealer
rings and anchors alternating along the length of the body. With
respect to each of these various embodiments, portions of the
exterior surface of the body that are free from both sealer rings
and anchors can be used for the placement of elements that
facilitate therapeutic or diagnostic procedures, such as ultrasound
diagnosis, radio-frequency ablation, and drug delivery. The anchors
or sealer rings can also be positioned to accommodate any of the
various position sensing components described in the copending
application Ser. No. 60/036,944.
FIGS. 17-18 show another embodiment 300 of the urethral device. In
this embodiment, the anchors 320 are formed as offset sinusoidal
protrusions along the body 16. These anchors 320 have relatively
larger surface profiles that allow for more contact with the
urethra 30 and that extend over a small portion of the exterior
(FIG. 17) or over all of the exterior (FIG. 18).
Referring to FIGS. 24 and 24A, there is depicted another embodiment
500 of the urethral device. This device 500 is similar to the
previously described devices and includes a tubular body 16. In
this device the anchors 520 do not spiral around the tubular body
16 but instead encircle it, i.e., the point of divergence 524 is at
the same axial position along the length of the tubular body 16 as
the point of convergence 525. As in the other embodiments, each
anchor 520 has a middle portion 521 having a greater height or
amplitude, and leading and trailing end portions, 522 and 523, that
taper from the middle portion 521 to the points of divergence and
convergence 524 and 525. As described above, the maximum amplitude
may extend along the middle 8 portion 521 or may be located toward
one of the end portions.
Referring to FIGS. 25 and 25A, there is depicted another embodiment
600 of the urethral device. This device 600 is similar to the
device depicted in FIGS. 24 and 24A, except that the device 600 has
six anchors 620 instead of only two. As in the previously described
embodiments, the anchors 620 are preferably located in a random or
irregular pattern.
Referring to FIGS. 26 and 26A, there is depicted another embodiment
700 of the urethral device. This device 700 is similar to the
devices depicted in FIGS. 24, 24A, 25 and 25A except that the
device 700 has rectangular anchors 720 that extend generally
longitudinally along the length of the body. These anchors 720 are
parallel to the axis 15 of the tubular body 16 and serve to keep
the device 10 positioned in place. These anchors 720 are preferably
located in a random or irregular pattern.
Valved Embodiments: According to a further aspect, the device may
include a valving mechanism to control the flow of fluid through
the device. Any of the above described embodiments of devices for
positioning in the urethra are compatible with the implementation
of valves or other urine-control elements. Valved embodiments may
require more or larger anchors than unvalved devices because of the
additional forces incumbent upon the valve. Thus, surface and size
modifications of the device can be purposefully made to produce an
adequately anchored device.
FIG. 19 through FIG. 23 illustrate one such embodiment 400 of a
valved urethral device. The tubular body portion 416 of the valved
device 400 may be similar to any of the above described
embodiments. The device 400 has a proximal end 412, a body 416, and
a port 418. (The distal portion of the device 400 is not shown.)
Within the body 416 is a magnetic assembly comprising a magnetic
tumbler 480 (shown in elevational views in FIG. 20) that is held in
place axially by a pin 482 and a journal 483 which cooperates with
a shaft 484 of a stopper 486. The pin 482 is supported by a distal
support flange 485 (shown in more detail in FIG. 21), and the shaft
484 is supported by the proximal support flange 487 (shown in more
detail in FIG. 22).
The distal end 488 of the shaft 484 is cam-lobe shaped and fits in
a latch insert 490 of the magnetic tumbler 480. In the closed
position, the distal end 488 of the shaft 484 is in a non-aligning
orientation with a keyway 492. When the magnetic tumbler 480 is
caused to rotate by use of a magnet 470 located external of the
body, the distal end 488 of the shaft 484 aligns with and moves
distally along the keyway 492 of a latch insert 490, causing the
stopper 486 to likewise move distally and open a fluid-flow channel
494 of a seat 496. The flow of fluid (in this case, urine) causes
the stopper 486 to remain in a distal or open position.
This rotation and resulting alignment and cooperation of parts
results in a magnetic latching system that is an improvement over
prior systems. The magnetic torque required to rotate the magnetic
tumbler 480 and thus activate the flow of fluid is much less in the
disclosed system compared to a prior art system that requires
magnetic torque to overcome a magnetic circuit between two parts.
In the disclosed system, the magnetic tumbler 480 is not required
to overcome a direct hydraulic force without mechanical advantage
but rather is required to overcome only minimal frictional forces
to "unlatch" the stopper 486. After the disclosed system is
unlatched, the hydraulic pressure within the fluid provides the
necessary work and force necessary to displace the proximal end 497
of the stopper 486 from the seat 496 and open the fluid-flow
channel 494. Activation of this latching system requires a minimum
force of magnetic field.
The magnetic tumbler 480 in the disclosed embodiment is preferably
made of Neodynium or Symarium-Cobolt. The magnetic flux density of
the magnetic tumbler 480 is preferably greater than 7500 Gauss. The
external magnet 470 of the disclosed embodiment is constructed of
the same material but has a greater physical dimension. The
external magnet 470 is preferably cylindrical and poled axially
with a diameter of 0.75 inches and a length of 3 inches. The latch
insert 490 is preferably made of a low nonmagnetic material which
has a low coefficient of friction such as PTFE.
When fluid flow has nearly or completely ceased, the combined force
of springs 498a, 498b and 498c, which act upon the proximal end 497
of the stopper 486, has sufficient magnitude to displace the distal
end 488 of the stopper 486 within the keyway 492 and then lightly
compress the proximal end 497 of the stopper 486 against the seat
496, thus closing the fluid-flow channel 494. The springs 498a,
498b, and 498c are constructed of 304 high-tensile stainless steel
and provide a maximum combined force of less than 0.3 grams when
the stopper 486 is in the open position. The force of the springs
498a, 498b, and 498c is insufficient to overcome the hydraulic
pressures that are incumbent upon the proximal end 497 of the
stopper 486. The resultant axial displacement versus force profile
is nonlinear.
When fluid flow ceases, the stopper 486 is returned proximally to a
closed position by the springs 496a, b and c, which position the
stopper 486 in a closed position. The proximal end 497 of the
stopper 486 is slightly deformable to make a better seal with the
seat 496. The proximal end 497 of the stopper 486 is preferably
made of a low-durometer material with a durometer less than 100
Shore A. The magnetic tumbler 480 then rotates back to its initial
position prior to initiation. The re-indexing occurs due to the
light magnetic field coupled between the tumbler 480 and the metal
index surface 493 on the body 416.
The magnetic tumbler 480, the seat 496, the proximal support flange
487, and the distal support flange 485 are all shaped with
through-holes or passages to allow for the maximum fluid flow
volume. Urine flows in through the port 418, through the magnet
assembly, through the inner lumen 499, and out the distal end of
the device 400.
As a safety feature, the proximal end 497 of the stopper 486
deflects in the event that pressurization of the fluid exceeds
approximately 40 cm of water for a time period of several seconds
without intermittence. This feature allows for the relieving of a
bladder that is excessively pressurized in order to prevent reflux
into the kidneys.
Advantages of the Disclosed Embodiments: The disclosed embodiments
provide several advantages over prior devices intended for urethral
placement. The disclosed embodiments provide for some or all of the
following advantages relative to prior devices: (1) ease of
insertion, (2) secure retention in the urethra, (3) a mechanical
advantage that permits a device with a larger effective diameter to
be inserted in the urethra with the effect of inserting a smaller
device, (4) minimal trauma and irritation to the urethra, and (5)
improved sealing of the device with the urethra to prevent leakage
of urine around the perimeter of the device.
1. Ease of Insertion. Insertion and removal of some of the
disclosed devices may be facilitated by the rotational movement of
the device. The rotation provides for the advancement or retraction
due to the interaction of the relatively short anchors, in
particular in the embodiments in which the anchors have helical
surfaces, with the surface of the urethra with which they are in
contact. Additionally, each surface is provided with a varying
height which is similar to an elongated sinusoidal profile to
further reduce abrasion during the positioning of the device.
2. Secure Retention. Once in place, the urethra or bladder neck is
better able to conform to the anchors and provide for secure
retention. Minimizing the length and surface area of the individual
anchors with the urethra allows for reduction of stress. Increasing
the area of the flat, extended surfaces between the anchors and
keeping to a minimum the area of the protrusions themselves aids in
securing the device because the urethra will provide some friction
with the flattened surface as well. An effective balance between
the flat (non-anchors) and raised (anchors) areas of the device can
be achieved to provide for secure retention while minimizing the
areas of the urethra that are stressed due to contact with the
anchors. Using the minimum number of anchors necessary to
effectively secure the device allows a large portion of the urethra
to be in a more relaxed, natural state. This is particularly
important due to the vulnerability of the urinary tract to
infections. Damage to the inner mucosal layer may be a major
contributor to an individual's susceptibility to urinary tract
infections. Some or all of the disclosed embodiments minimize the
surface irritation during positioning and retention and further
minimize the effect of restriction of intercapillary blood
circulation which effectively perfuses the urethra and the
surrounding tissues by limiting the continuous length of the
stressed urethral surface.
3. Mechanical Advantage. Some or all of the disclosed embodiments
permit a device with a larger effective diameter to be inserted in
the urethra with the effect of inserting a smaller device. As the
anchors engage the urethral wall while the device is being
inserted, the device is advanced through the urethra.
4. Minimum of Trauma and Irritation. The anchors may be patterned
in a non-uniform manner in order to minimize any abrasion of the
intraurethral mucosa due to repeated contact of anchors with the
urethra as the device is moved along the passageway. A uniform
pattern might cause the same areas of the urethra to be contacted
by succeeding anchors as the device is rotated.
5. Sealing. As described above, in the preferred embodiments the
anchors are not used for sealing. Instead, sealing is accomplished
by one or both of the following. The first means by which sealing
is achieved is by the wall of the urethra bearing against and
sealing against the relatively long, flat surfaces between the
anchors of the device. The second means by which sealing is
achieved is by the use of a secondary system of soft and pliable
circumferential sealer rings designed specifically for restriction
of fluid flow along the exterior of the device. These sealing rings
are not designed to secure the device, but rather to restrict the
flow in a non-traumatic manner.
It is to be understood, however, the even though numerous
characteristics and advantages of the present invention have been
set forth in the foregoing description, together with details of
the structure and function of present invention, the sequence or
order of the specific steps, or the actual compositions,
environmental conditions, and the like experienced or sensed may
vary somewhat. Furthermore, it will be appreciated that this
disclosure is illustrative only and that changes may be made in
detail, especially in matters of shape, size, arrangement of parts,
or sequence of elements of the various aspects of the invention
within the principles of the invention to the full extent indicated
by the broad general meaning of the terms in which the appended
claims are expressed.
* * * * *